Monthly Archives: March 2016

No place but cells for those having mental breakdowns

This situation is the result of prolonger and covert capacity rationing. The rationing occurs in training, plant, support services and all aspects of mental health.

Alice Thomson, Rachel Sylvester in the Times 28th March 2016 report: No place but cells for those having mental breakdowns


The police are picking up the pieces for cuts to mental health services because they are the “bank that can’t say no”, according to the independent watchdog.

Dame Anne Owers, head of the Independent Police Complaints Commission, said that forces would struggle with a law limiting the use of police cells for those suffering a mental health crisis because there was nowhere else to take them. “The criminal justice system becomes the gateway to mental health service because it’s the bank that can’t say no,” she said. “It’s no good just saying the police shouldn’t be dealing with these people; you’ve got to ask the question, ‘Who should?’ ”

Legislation going through parliament will make it illegal for children to be detained in a police cell during a mental health crisis and limit the circumstances in which adults can be held there. It is an issue on which The Times has been campaigning as part of its Time To Mind initiative.

Dame Anne said that apart from training the police to deal properly with people in mental health crisis there need to be many more services to deal with them. She said that half of the people who die in police custody or immediately afterwards are known to have mental health problems.

Sir Bernard Hogan-Howe, the Metropolitan Police commissioner, said that mental health was a significant problem. “We were treating it as a marginal issue when in fact 40 per cent of the people we come across have got a mental health issue,” he said.

Staff speak out against NHS watchdog – no NHS resurrection is likely

Kate Gibbons in The Times 29th March 2016 reports: Staff speak out against NHS watchdog

Pressure is mounting on the NHS ombudsman to resign as whistleblowers at the watchdog expose a “toxic environment” fuelled by unachievable targets with hundreds of patients’ complaints remaining unsolved.

Dame Julie Mellor, the parliamentary health services ombudsman, has been accused of creating a climate of fear in which workers are penalised for raising concerns that patients’ complaints are poorly handled and pushed through simply to meet targets. Last week about 180 members of the executive committee of the Public and Commercial Services Union backed a motion of no confidence in her.

This month Mick Martin, Dame Julie’s deputy, took leave of absence pending an investigation into allegations that he helped to cover up a sexual harassment case at a hospital that cost the taxpayer almost £1.5 million.

A handful of current and former staff have spoken out against the PHSO. Their testimonies, published by the Health Services Journal, reveal an atmosphere in which inadequacy and poor quality are accepted.

One member of staff said: “It would be better to provide no service at all than to give service users false hope that their concerns will be meaningfully investigated.”

A spokeswoman for the PHSO said: “Our staff are our greatest asset. We are working positively with staff and trade unions to address the issues they have raised, as we continue to modernise our service for the benefit of the public.”

NHS errors in Wales double under Labour . A possible sign of cultural change? Or worse, “reality”….

Collapse, fear and disorder. A post-coded anarchy of lowering medical quality and standards is coming…

Who will resurrect the NHS? No miracle is forthcoming…

NHS errors in Wales double under Labour . A possible sign of cultural change? Or worse, “reality”….

The Investigating clinical incidents in the NHS – United Kingdom situation is now an “on line” report process, which is centralised.

Sanya Burgess for The Sunday Times reported 27th March 2016: NHS errors in Wales double under Labour .

Now this could well be good news, as it may indicate that staff are less inhibited than they were before about reporting incidents. It could be bad news, but NHSreality very much doubts the numbers have altered that much. There may be a worsening in the figures, as NHSreality predicts a managed decline degenerating slowly into post-code anarchy….. Do you believe in luck – or NHSreality?

THE annual rate of serious health service blunders resulting in death or injury has more than doubled under Labour, according to official figures.

More than 900 “serious untoward incidents” (SUIs) were recorded in 2014-15 compared with 414 in 2011-12.

The number of SUIs at the Betsi Cadwaladr University Health Board in north Wales rose from 100 to 303 over the same period, and the Hywel Dda University Health Board in west Wales saw an increase from 25 to 82.

This weekend, Darren Millar, the Tories’ shadow health minister who obtained the figures, demanded an independent inquiry and accused members of the Welsh government of “burying their heads in the sand”.

He said: “Incidents such as these where patients could come to serious harm or death are avoidable and should never happen. The fact that they are rising and have increased threefold in some health boards in recent years is very concerning and provides further evidence of the impact of Labour’s record-breaking cuts on the NHS budget in Wales.

“One avoidable death is one too many, and the alarming rate at which these incidents are being reported to the health minister suggests there are problems which need to be urgently addressed.”

However, Mark Drakeford, the health and social services minister, accused the Conservatives of “yet another sloppy attempt to attack the Welsh NHS”. He said the increase was the result of staff being encouraged to speak up when things went wrong.

“The number of incidents has increased because we have asked the Welsh NHS to report more things . . . NHS staff are encouraged to report all incidents, including near misses,” he said.

David Williamson reports for Walesonline 15th Jan 2015: Labour attacked on performance of Welsh NHS as new report compares our service with England’s so this is a sustained attack. It will only be solved once WHO reports on the comparative results (Maternal Mortality, perinatal mortality, life expectancy) between the different UK health systems.

Collapse, fear and disorder. A post-coded anarchy of lowering medical quality and standards is coming…

Endemic cultural failure – managed decline only is possible without the staff…


Failure to recruit more GPs raises safety fears – don’t say you weren’t warned.

Kate Gibbons in the Times 28th March reports: Failure to recruit more GPs raises safety fears and provides the GP slant on the reality of the previous posting. Stress levels in junior  doctors, and fear in all staff is leading to implosion. (Collapse, fear and disorder. A post-coded anarchy of lowering medical quality and standards is coming… ) NHSreality has warned for 3 years…. Denial is the politicians problem. Disengagement is a problem for Drs and politicians.

Fewer than half the new GPs that the government promised to recruit will have joined the profession by 2020.

Jeremy Hunt, the health secretary, announced plans to train and retain an extra 5,000 GPs in England by the end of the decade at the Conservative party conference in 2014.

However, just over 2,000 are expected to join and the number of unfilled GP posts continues to rise. Senior doctors have warned that patients’ lives are at risk as struggling emergency departments are forced to pick up GPs’ workload and the health service has been forced to turn to the private sector for expensive agency staff as emergency services, GPs and out-of-hours NHS services fail to cope.

Analysis of the figures, carried out by Pulse magazine, shows that the GP workforce will increase by 2,100 at best, despite a £10 million recruitment scheme that includes “golden hellos” of £20,000 and a high-profile government publicity campaign.

New figures from the Royal College of General Practitioners show that in 16 areas of the country, including large parts of Kent, London, Dorset and Gloucester, more than 25 per cent of GP posts are empty. Among the worst hit areas are Bexley in southeast London, Redbridge in northeast London and Swale in Kent, which all have about half the number of doctors needed to cover their population.

The British Medical Association called the health secretary’s 2014 pledge wholly unrealistic. It estimates that at the current training rate 13,000 GPs will enter the system by 2020. However, 3,500 GPs have applied for certificates to work abroad and 7,200 are likely to have retired.

Krishna Kasaraneni, chairman of the BMA GP education, training and workforce subcommittee, said that the data analysis revealed how short they were likely to be. He added: “We actually need a lot more GPs than this arbitrarily chosen figure [of 5,000] to maintain a basic level of service to patients. With 600 GP trainee posts left unfilled last year and large sections of the workforce telling the BMA they intend to retire, there is little chance the government will get anywhere near this target.”

Figures from the General Medical Council, the regulator, show that 700 GPs in England are applying to work abroad each year and the NHS Business Services Authority, which administers NHS pensions, said that about 1,400 GPs retired in 2014. The 2020 predictions do not take into account any increase in GPs taking early retirement. A BMA survey last year found that one in three GPs hoped to give up work in the next five years.

Application numbers will also be affected by the new junior doctor contracts, according to the BMA.

The government recently started to emphasise that the target was for 5,000 extra “doctors in general practice” rather than fully-qualified GPs, which means trainees will be counted. A Department of Health spokesman said that NHS training bodies were working with the BMA and royal college to boost recruitment. He added: “We have been clear that our target includes [trainees].”

Image result for gp recruitment cartoon

And just to confuse you, and make you question the manpower planning completely the Abi Rimmer in BMA news reports: Sugical Training Posts could be reduced to avoid oversupply. (BMJ careers 13th Feb 2016) – the opposite of 6 years ago when, in The Telegraph 1st May 2010 Rebecca Smith warned: Cuts being made to junior doctors’ posts experts warn – Up to one in three jobs for trainee surgeons will be cut over the next three years in some areas meaning doctors will be ‘spread too thinly’, it has been warned.

Overcapacity is the best way to control supply within a profession. 10% discard rate allows for emigration and career changes and drop outs..

Collapse, fear and disorder. A post-coded anarchy of lowering medical quality and standards is coming…

The level of distress and alienation among junior doctors taking strike action is a ‘matter of serious concern’, the GMC chairman has warned.

Link to article at GP magazine

Collapse and disorder. A post-coded anarchy of lowering medical quality and standards is coming… Undercapacity is the rule in 2nd and 3rd world countries, but we do not expect it in the UK. The reality has yet to strike the ublic, until they are ill themselves. Sometimes they realise when its their nearest and dearest who are rationed (restricted, excluded, prioritised, denied, delayed). Further evidence is in the articles below:

Skinhead can't get swastika right. Other man says: 'Maybe you should think about becoming an anarchist like me.'

Sarah-Kate Templeton in the Sunday Times 27th March reports on an incident/anecdote which is symptomatic of the whole. Baby death may lead to more doctors,

THE tragedy of a baby who died when no consultant was available in the hospital to help with her complicated delivery has prompted a review of staffing guidelines following the intervention of the minister for maternity care.

Ben Gummer has alerted the National Institute for Health and Care Excellence (Nice) and the Royal College of Obstetricians and Gynaecologists to concerns raised by a coroner over the absence of a consultant obstetrician during the birth of Bonnie Strachan at Ipswich Hospital in January 2015…..

The social contract whereby staff are protected is also being challenged. The legal issues involved are explored by Dr Narinder Kapur  in The Times 18th March 2016 :Discipline in the NHS and the death of Amin Abdullah

The fear of whistleblowing is endemic. The powerful gagging which is in all but a few of the Trusts in the UK medical services is a disgrace. The disciplinary procedures are so cumbersome and pedantic that the service itself is at risk. Trusts in “special measures” are not necessarily the only ones with the problem of bullying and inept management. The perverse incentives that drive these inhibitions need to be addressed. It may be too late to do this at National level. My personal belief is that the Trusts have to be made completely independent (an acknowledgement that there is no NHS) before the whole is re-formed – under a new constitution which recognises the need for overt rationing, the encouragement of autonomy, and allows teams to determine their own destiny with pride.

Read the whole dismaying article here: Discipline in the NHS and the death of Amin Abdullah

The lack of exit interviews throughout the health services is reflected in the feelings of the cleaning staff at the Maudesley. Uncherished and undervalued. One of the problems Trust boards and CCGs have is that when services are contracted out they feel no obligation to cherish, value or listen to these staff.

Nadine Houghton on 21st March writes in the Guardian: Why we should listen to the cleaners on strike at the Maudsley hospital

In an un-rationed health service that addresses fear without reference to means, PrEP should of course be funded. It is reasonable not to fund, but unreasonable not to call this rationing.

Nicola Slawson reports in The Guardian 21st March 2016: NHS England stalls plans for HIV prevention method known as PrEP

Consultation on Truvada will now be shelved, in move sexual health charities have described as ‘shameful’ and ‘failing those at risk’ of HIV

This is just the start of civil unrest. The patients will cause a lot more problems than the doctors. Strike won’t cure sick NHS

The start of “Civil Unrest” in the Regional Health Services – as predicted by NHSreality?

Cartoon: Anarchy of grandchild (medium) by bgurcay tagged anarchy,cartoon,comic

Liberal beliefs need to be modified pragmatically to create a sustainable health service – especially in Wales

This site has been running for 3 years, and the majority of readers are professionals in the Health Services and supporting areas. You can follow by either registering ” on site” or by asking me to “link in” or become friends through facebook. For twitter feed you do not need to link and I have no idea of how many followers of NHSreality there are. Please spread the word with the link to all your contacts… the former NHS has gone, and the Regional Health Services are dying. There is now no NHS according to WHO: but we were all of us children of the original NHS.. Politicians are in denial and letting everyone down with their dishonesty..

The new philosophy of honesty and the inconvenient truth of covert rationing is explained,


in the beginning we pointed out the impossibility of quality and cost objectives both being met.

Recently another GP, John Evans from Solva has joined me in postings. He and I have different positions on the EU but otherwise we concur on the UK health services.

The major theme is that as a mutual all health services are more powerful if they are larger. They can offer more specialist services, more choice, and better outcomes. We feel that there is no longer, in practical ways that apply to citizens/patients, a National Health Service.

We believe obfuscation and denial, by politicians and the media, has led to a situation where the professionals no longer believe that their health service is founded on a rock, either ideologically or financially.

The result has been increasing “covert rationing” as technology and information advances faster that the state’s ability to pay.

The outcome of this is an increasing health divide. Those who can choose to exercise choice and go privately. Those who cannot suffer longer waiting times, lack of choice, worse outcomes and in the end this will lead to shorter lives.

Our suggestions are several and have (some of them) been adopted by BMA Wales. Meetings have poor turnouts due to a disengaged profession but those who have done have been persuaded. The suggestions all address the longer term. We have no solutions to GP and Nurse shortages in the shorter term other than importing them, as we have done in the past. If we do this standards will fall and opportunities for our own to train and find work will be reduced in the same cycle of undercapacity as we entered in the 1960s. To protect a longer term solution imported staff should be on 10 year visas with renewable options at the discretion of local authorities.


  1. Exit interviews should be done on all Health Service Staff, especially nursing sisters, consultants and board members, by an independent HR body. These should be summarised and fed back to Deaneries, Trust Boards and the Ministers in a depersonalised way at 6 monthly intervals. Retiring staff should have the option to put their exit interview in the public domain, provided it is not libellous.
  2. Rationing should be made overt. Trust boards should be free to ration low cost high volume services in their area. Regions should make the rationing decisions at Regional level for the low volume high cost treatments. Obviously, we can have more of the latter if we have less of the former.
  3. Medical Training should be “post-graduate” and not undergraduate. (Gender bias dealt with) and the Deaneries should be forced to send their students out into the periphery, where they will be based on DGHs. They need only attend Cardiff for assessments, and most teaching and tutorials can be “on line”. In this way doctors and nurses will become part of a community at a younger age, and more likely to stay.
  4. Whistleblowers need to be the first people in the honours list. The educational portfolios should have a “bullying” and a “poor culture” button which alerts the educational supervisor and the Deanery concurrently. The trainee should be taught how to protect himself by only entering such reports once he has been signed up.
  5. Elected representatives need their constituencies to be coincident with “health Areas” so that perverse decisions are less likely and exposed.. PR of any form will help less perverse incentives and outcomes such as the one to destroy the chances of a new build hospital at Whitland/Narberth some 8 years ago. Health boards need to be equally representative, and debates about ideology conflicting with finance need to be overt.
  6. In the end people will never be completely happy with a health service, but they will appreciate the inconvenient truth: we cannot have everything for everyone for ever. Pragmatic and overt rationing whereby citizens know what is not available to them is better.
  7. Fairness may demand different levels of rationing for those on different incomes.
  8. Co-payments for example could be geared to income tax codes, through an identity card. This would be revolutionary, but such a card could be used at times of war (the new war may be constant and terrorist related)

to monitor movements at all transport points, used for bank account entry etc. I appreciate this is illiberal, but it is a debate we need before the big terrorist event rather than after. Liberal need to think, in all our policies, where liberty ends. If the benefit to society justifies a relatively small loss of liberty then I support it. For example, ID cards at transport points could be discarded if things look up.

  1. One health authority for 3m people in Wales is sufficient. It would win the votes of most of the health professionals as they would regain choice. Why did we vote against Plaid?
  2. All health services should have the true cost printed on them, and the cost to the patient alongside. If “free” or a co-payment it matters little. Prescription charges could be reintroduced on a sliding scale if we linked to an ID tax card. Charges might be pragmatic for A&E(higher for drunks), and for GP visits, once again with sliding scales.
  3. Foreign Nationals without an E111 would be charged immediately by bank card.

I look forward to Greek style  debates on some of these issues. If we do not put our Welsh Health Service on a secure financial footing we are going to perpetuate the opposite of what Aneurin Bevan intended, and increase inequalities. It has already happened in Dentistry and Physiotherapy, (and Legal Aid), and shortly it will happen – private GPs will begin.

A new philosophy, what I believe: allow Trust Board members to use the language of rationing in media press releases

Terrifyingly, according to the World Health Organisation definition the UK no longer has a NHS

A reminder in poetry: “I am a child of the NHS”

A poem a day will keep your loss of empathy at bay, doctor

London GP services crisis pending… Overseas doctors will probably fill the vacancies. Watch for private GPs and Private A&E departments in the capital…




A miracle is needed this Easter – for the UK Health Services. Hubris after grounding will not be enough..

NHSreality has already commented on the need for a miracle. Denial is part of the Easter story and the cock is crowing for Mr Hunt. His negotiations with the consultants are at risk in the same way as those with the juniors. Trying to solve a problem of 20 years in the incubation in a week is the impossible miracle that is needed. Whilst the rich people of Hampstead will exercise choice, by pass waiting lists and queued rationing, those in Scunthorpe (Wards closed) and Hastings (Special Measures) will have to put up with what they get. E.g.: Alan Travis in The Guardian 24th Feb 2016: Ministers and NHS bosses criticised over use of overseas nurses: Chief of government’s migration advisory committee says there is ‘no good reason’ why nurses cannot be found in UK. On the same day Dennis Campbell reports Sir Bruce Keoch, also in denial: Junior doctors row has derailed seven-day NHS plans, says top doctor. Sir Bruce Keogh signals unhappiness with Jeremy Hunt’s decision to impose contract and rejects justification of new terms

The Health Service miracle will not come of course. Icarus could not fly and neither can Mr Hunt or the Staff. Pigs do not have wings.. and they do not fly well in hurricanes…. (Adam Roberts 24th March 2016 in The Guardian: The NHS is in the midst of a financial hurricane )



The truth came home to Dr Megan North reflects on her life saved by her own intervention 4 years ago. The Guardian 25th Jan 2016: I nearly died because the hospital was so short of staff . This type of standard reduction is commonplace, universal, endemic… The people of Hampstead know it… and vote with their feet. The Doctors and Nurses know it and are voting with theirs.. The MPs know it and go privately.

The cock crowed 3 times for Paul, and he relented and told the truth. Mr Hunt, please relent and realise that overt rationing is the only realistic and pragmatic way to provide the miracle needed. Once on the ground the health services can never take off again, and hubris will not be enough.

Not only patients will need a miracle – the UK Health Trust Boards and CCGs need to go to Lourdes

In the news today:

Giles Sheldrick in the Express 24th March 2016: Holiday rush to A&E could cost the health service £10 MILLION NON-urgent visits to hospital accident and emergency departments over the Easter weekend could cost the cash-strapped NHS almost £10million, it was claimed last night.

The Sun reports: NHS at breaking point as patients overwhelm A&E. Third world NHS. 12 Hospitals in Crisis. Worst waiting times in 10 years.

Alan Travis in the Guardian reports on another denial: Ministers and NHS bosses criticised over use of overseas nurses -Chief of government’s migration advisory committee says there is ‘no good reason’ why nurses cannot be found in UK